title: Thoracic endovascular repair as a safe management strategy for aortobronchial fistulas.
abstract: OBJECTIVE
  This study assessed the safety and efficacy of thoracic endovascular aortic repair (TEVAR) in the management of aortobronchial fistulas.
  
  
  METHODS
  A retrospective review was performed at Emory University Hospital to identify all patients who presented with an aortobronchial fistula. The diagnosis was based on clinical, radiologic, and bronchoscopic findings. Patients who underwent TEVAR as definitive management of these fistulas were identified. Demographics, history of thoracic aorta pathology or intervention, type and number of endografts used, need for reoperation, and clinical and radiologic follow-up data were collected for each individual.
  
  
  RESULTS
  Between 2000 and 2009, 11 patients received TEVAR as definitive management of aortobronchial fistulas. Technical success was achieved in 10 patients (91%). Six patients (55%) had previously undergone thoracic aortic surgery. A proximal type 1 endoleak developed in one patient after graft deployment and required reintervention for additional graft placement. No intraoperative or 30-day deaths occurred. Postoperative clinical and radiographic assessment was a mean of 8.8 months (range, 1-40 months). For all 10 patients in whom technical success was achieved at the initial operation, no endoleaks were noted at the follow-up CT scan. In addition, no patient required a further intervention.
  
  
  CONCLUSIONS
  This study represents the largest reported series on the use of TEVAR in the management of aortobronchial fistulas. Supported by postoperative surveillance imaging and clinical evaluation, TEVAR has proven to be a safe and effective management strategy for an otherwise lethal condition. Long-term follow-up data are needed to ascertain the durability of this approach.
authors.affiliation: Emory University Hospital, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Bailey
authors.forename: Seth
authors.initials: S
authors.lastname: Force
authors.forename: Ross
authors.initials: R
authors.lastname: Milner
authors.forename: Karthikeshwar
authors.initials: K
authors.lastname: Kasirajan
authors.forename: Ravi K
authors.initials: RK
authors.lastname: Veeraswamy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D001018:Aortic Diseases / Q000175:diagnosis / Q000601:surgery*; D001027:Aortography / Q000379:methods; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation; D001983:Bronchial Fistula / Q000175:diagnosis / Q000601:surgery*; D001999:Bronchoscopy; D057867:Endoleak / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000009:adverse effects / Q000295:instrumentation; D005260:Female; D005845:Georgia; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D012086:Reoperation; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016157:Vascular Fistula / Q000175:diagnosis / Q000601:surgery*